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      Conscious sedation in Spanish dental schools: Current situation

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          Abstract

          The current Spanish curricula for degrees in dentistry include conscious sedation (CS) as a basic training competency. However, is the CS training delivered by Spanish dental schools a consensus‐based educational framework enabling students to use this anesthetic technique after graduation? To answer this research question, a study was designed aiming to identify the strategies used to teach this competency in Spanish dental schools and the characteristics of teaching. The authors reviewed legislation concerning officially established requirements for a degree in dentistry as well as curricula currently taught in Spain. Our analysis identified clear discrepancies among the schools of dentistry studied. The only overlap was observed in reference to the level of proficiency imparted, which prevents Spanish dentistry students from using this anesthetic technique after graduation. Specific features of the normative framework and of the Spanish legislative system underlying the design of the present curricula of degrees in dentistry would explain the discrepancies in CS competencies taught at our schools of dentistry. Almost 10 years since its implementation and in light of the new demands of the complex society in which we live, Spanish universities must unify their educational criteria regarding CS training to ensure the appropriate qualification of our new dentists in this technique.

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          Need and demand for sedation or general anesthesia in dentistry: a national survey of the Canadian population.

          The aim of this study was to assess the need and demand for sedation or general anesthesia (GA) for dentistry in the Canadian adult population. A national telephone survey of 1101 Canadians found that 9.8% were somewhat afraid of dental treatment, with another 5.5% having a high level of fear. Fear or anxiety was the reason why 7.6% had ever missed, cancelled, or avoided a dental appointment. Of those with high fear, 49.2% had avoided a dental appointment at some point because of fear or anxiety as opposed to only 5.2% from the no or low fear group. Regarding demand, 12.4% were definitely interested in sedation or GA for their dentistry and 42.3% were interested depending on cost. Of those with high fear, 31.1% were definitely interested, with 54.1% interested depending on cost. In a hypothetical situation where endodontics was required because of a severe toothache, 12.7% reported high fear. This decreased to 5.4% if sedation or GA were available. For this procedure, 20.4% were definitely interested in sedation or GA, and another 46.1% were interested depending on cost. The prevalence of, and preference for, sedation or GA was assessed for specific dental procedures. The proportion of the population with a preference for sedation or GA was 7.2% for cleaning, 18% for fillings or crowns, 54.7% for endodontics, 68.2% for periodontal surgery, and 46.5% for extraction. For each procedure, the proportion expressing a preference for sedation or GA was significantly greater than the proportion having received treatment with sedation or GA (P < 0.001). In conclusion, this study demonstrates that there is significant need and demand for sedation and GA in the Canadian adult population.
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            The Odyssey of Dental Anxiety: From Prehistory to the Present. A Narrative Review

            Dental anxiety (DA) can be considered as a universal phenomenon with a high prevalence worldwide; DA and pain are also the main causes for medical emergencies in the dental office, so their prevention is an essential part of patient safety and overall quality of care. Being DA and its consequences closely related to the fight-or-flight reaction, it seems reasonable to argue that the odyssey of DA began way back in the distant past, and has since probably evolved in parallel with the development of fight-or-flight reactions, implicit memory and knowledge, and ultimately consciousness. Basic emotions are related to survival functions in an inseparable psychosomatic unity that enable an immediate response to critical situations rather than generating knowledge, which is why many anxious patients are unaware of the cause of their anxiety. Archeological findings suggest that humans have been surprisingly skillful and knowledgeable since prehistory. Neanderthals used medicinal plants; and relics of dental tools bear witness to a kind of Neolithic proto-dentistry. In the two millennia BC, Egyptian and Greek physicians used both plants (such as papaver somniferum) and incubation (a forerunner of modern hypnosis, e.g., in the sleep temples dedicated to Asclepius) in the attempt to provide some form of therapy and painless surgery, whereas modern scientific medicine strongly understated the role of subjectivity and mind-body approaches until recently. DA has a wide range of causes and its management is far from being a matter of identifying the ideal sedative drug. A patient's proper management must include assessing his/her dental anxiety, ensuring good communications, and providing information (iatrosedation), effective local anesthesia, hypnosis, and/or a wise use of sedative drugs where necessary. Any weak link in this chain can cause avoidable suffering, mistrust, and emergencies, as well as having lifelong psychological consequences. Iatrosedation and hypnosis are no less relevant than drugs and should be considered as primary tools for the management of DA. Unlike pharmacological sedation, they allow to help patients cope with the dental procedure and also overcome their anxiety: achieving the latter may enable them to face future dental care autonomously, whereas pharmacological sedation can only afford a transient respite.
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              Sedation in Japanese dental schools.

              There is very little information about the practice of sedation in Japan. Despite the remarkable advances in dentistry, fear and anxiety continue to be significant deterrents for seeking dental services. Most dental procedures can fortunately be undertaken with the aid of sedation. A comprehensive survey of all the dental schools in Japan was carried out to determine what sedation practices were used in Japan. All 29 dental schools in Japan possessed a dedicated department of anesthesiology at the time of this survey. The survey attempted to determine the specific sedation methods (techniques, routes of administration, and agents used in sedation) as well as practices (monitoring, fasting, location, education, and fees involved in sedation). The results indicate that there was a broad range in sedation practices. The Japanese Dental Society of Anesthesiology may wish to examine the findings of this study and may wish to formulate guidelines appropriate for the practice of sedation in Japan. Others may also wish to compare their own practices with those of Japan.
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                Author and article information

                Contributors
                lginer@uic.es
                Journal
                Clin Exp Dent Res
                Clin Exp Dent Res
                10.1002/(ISSN)2057-4347
                CRE2
                Clinical and Experimental Dental Research
                John Wiley and Sons Inc. (Hoboken )
                2057-4347
                09 May 2019
                August 2019
                : 5
                : 4 ( doiID: 10.1002/cre2.v5.4 )
                : 356-364
                Affiliations
                [ 1 ] Dental School International University of Catalonia (Universidad Internacional de Catalunya) Barcelona Spain
                [ 2 ] Education School International University of Catalonia (Universidad Internacional de Catalunya) Barcelona Spain
                Author notes
                [*] [* ] Correspondence

                Lluis Giner, Dental School, International University of Catalonia (Universidad Internacional de Catalunya), C/ Josep Trueta s/n, Sant Cugat del Vallès, Barcelona 08195, Spain.

                Email: lginer@ 123456uic.es

                Author information
                https://orcid.org/0000-0002-8458-5290
                https://orcid.org/0000-0003-3469-5819
                https://orcid.org/0000-0002-8714-8256
                Article
                CRE2190 CRE2.20190053.R1
                10.1002/cre2.190
                6704054
                4e42b161-eed6-43d6-96c9-f8619ce1fba1
                ©2019 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 16 March 2019
                : 12 April 2019
                : 15 April 2019
                Page count
                Figures: 1, Tables: 5, Pages: 9, Words: 2772
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                cre2190
                August 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.7 mode:remove_FC converted:21.08.2019

                competency,conscious sedation,curriculum,degree in dentistry

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